Healthcare Provider Details

I. General information

NPI: 1023672110
Provider Name (Legal Business Name): DEANA RACHAEL SCARBERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W CIVIC CENTER DR
SANTA ANA CA
92701-4515
US

IV. Provider business mailing address

405 W 5TH ST
SANTA ANA CA
92701-4599
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6660
  • Fax:
Mailing address:
  • Phone: 800-914-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number835668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: